The Dual Eligible Coalition
Committed to advancing federal policies that promote integration of care for individuals dually eligible for Medicare and Medicaid.
About The Coalition
The Dual Eligible Coalition is a group of multi-sector stakeholders including beneficiary advocates, managed care plans, provider systems, and behavioral health and social support service organizations that is informed by state advisors. The Coalition was founded to develop actionable, long-term policy and programmatic solutions to improve the delivery of care and outcomes for the dual eligible population.
The Coalition has been at work since 2017 to assess the challenges and opportunities facing the dual eligible population and the stakeholders who work with or serve them. The Coalition has developed a framework for fully integrating Medicare and Medicaid into a single program addressing medical, long-term care, behavioral, and social needs.
In conducting its work, the Coalition seeks to promote a set of principles around integration and whole-person care, including the following:
- Supporting Beneficiaries to Live as Fully as Possible
- Ensuring Comprehensive Integration
- Promoting State-Federal Partnership
- Ensuring Robust Reporting, Accountability, and Continuous Quality Improvement
- Aligning Incentives for Value-Based Care
- Promoting Consumer Engagement
The Coalition’s framework was developed through Coalition members’ input and expertise, as well as a structured stakeholder outreach process in which Leavitt Partners facilitated more than 40 individual conversations with a wide array of diverse stakeholders across the health care community, including with policy experts, providers, advocates, associations, and foundations.
The Opportunity to Improve Care
There are more than 12 million dual eligible beneficiaries enrolled in both Medicare and Medicaid. This is a diverse population that includes people with multiple chronic conditions, developmental and physical disabilities, mental illness, cognitive impairments, and social needs.
Both MedPAC and MACPAC have noted concerns raised as to how the existence of separate funding streams creates barriers to coordination of care and the extent to which lack of coordination increases costs and leads to poor health outcomes. Numerous researchers, health policy experts, states, and stakeholders have expressed interest in seeing more aligned incentives and integrated care to improve health outcomes and quality of care for dual eligible beneficiaries.
The Comprehensive Care for Dual Eligible Individuals Act
The Coalition is proud to support Sen. Sherrod Brown’s (D-OH) and Sen. Rob Portman’s (R-OH) recently introduced bill, The Comprehensive Care for Dual Eligible Individuals Act of 2022. The bill provides states with the option to develop an All-Inclusive, Integrated Medicare-Medicaid (AIM) Program, which provides state an option to—with robust CMS oversight—administer a single integrated program for full benefit dual eligible beneficiaries.
Beneficiaries that choose to participate in a state’s AIM Program would no longer have to navigate separate requirements from both Titles 18 and 19 of the Social Security Act to meet their complex needs (and neither would their families, caregivers, and providers). In addition to providing dual eligible individuals with comprehensive care, the AIM Program also modernizes financing by incentivizing states and administering entities they contract with to effectively manage care and removes disincentives for states to invest in dual eligible care.
The Coalition supports this legislation as a critical step for states to integrate program financing, administration, eligibility processes, and benefits to create the fullest, most integrated benefit possible for full benefit dual eligible beneficiaries. With more than 8 million full-benefit dual eligible individuals, the Coalition is committed to working collaboratively to legislatively advance its framework for fully integrating Medicare and Medicaid into a single program addressing medical, long-term care, behavioral, and social needs.
- Commonwealth Care Alliance
- Community Catalyst
- Health Plan of San Mateo
- Independent Living Systems
- Justice in Aging
- Kaiser Permanente
- L.A. Care Health Plan
- Medicare Rights Center
- National Alliance on Mental Illness
- UPMC (University of Pittsburgh Medical Center)
- Click here for the Dual Eligible Coalition Overview
- Click here for the Dual Eligible Coalition Financing
- Click here for the Dual Eligible Coalition Integration Timeline
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